Chief Pharmacist: From my lips to God's Ears

If I became the Chief Pharmacist today, first I will create a crisis by refusing to be a registrar of a Board that is another full time job in itself. I will be happy to be an ex-officio member of the Board, and I must not go there all the time because I have qualified deputies. I will then lobby to my Minister (or is it cabinet secretary?) to go to parliament to reduce my roles, if he ever wants me to deliver.

Then, I will have a national pharmacy strategy that aims to improve health from my department’s perspective. My strategy will and should be feeding to the larger strategy of the ministry responsible for health, and not standalone. I will make sure every person contributing to pharmaceutical services: pharmacists, technologists and other techs, and subordinates know this strategy and they have memorized it in their brains and hearts.

 If there is no strategy in place when I step into office on my first day or if the current strategy is in conflict with national strategy, I'll start addressing by addressing that. I will work through deputies who will have all the power to do what they deem fit for pharmacy; I will only ask them to be accountable and put their money where their mouth is.

I believe in human resource. The pharmacists under me must be the most competent in the world. They must be good public speakers, must be able to educate patients and public on the health, they should be able to engage constructively on general health issues and they must be able to design, test, monitor and improve healthcare programs that work. They must know their patients, and they must address their needs, they must be able to communicate understanding to them, they must love them and they must follow them up longitudinally. I will have to sample reports of such on my desk. No training opportunity that can make them the best in the world as a pharmacist can be swept under the carpet by me, because I will have no carpet. All trainings will be on merit, and on value for investment. If you will not do, don’t be trained. If you promise to do, and you don’t; no mechanism to get the value back from you will I spare.

Then I will focus on the needs of Kenyan public, and what they need a pharmacist for. I will not accept pharmacists to do what the Kenyan public does not need them to. I will happily bring to an end the era of 'boss pharmacists' because that is not what the consumers of health that I'm accountable to need.

I will fight for, protect and give pharmacists a larger slice of training opportunities than was allocated. I will not allow others to steal the show, or let DMS or whoever that will assume the responsibilities of the current DMS know more about pharmacy than me. I will not miss his meetings because he intimidates me, but he may miss my meetings because he fears accountability.

 All I will need of the pharmacists I will do anything for is not to embarrass me with apathy, dishonesty with themselves, stealing, empty heads, divided or no loyalties, inability or painstakingly slow minds, poor decision making skills, poor or no customer care, purposeful stagnation, caggy or caged thinking, being experts of anything else other than pharmacy, lack of accountability and personal responsibility, not being able to take advantage of opportunities given and excelling etc etc.

 I will be quick to enforce sanctions as I do with rewards. Finally, I will be on a fixed non-renewable contract of five years (or even four) to give others with better ideas chance to lead. If people really liked me, and want me to go on, I will only accept an advisory position.

I will whisper to my successor that anyone who spends or plans to spend a quarter century in a position is nothing more than a space occupying lesion.

Response to 26 March 2012 Daily Nation article titled 'Policing the drugs business'

This post is a reply to an article on Daily Nation of 26th of March 2012.

The original article can be accessed via this link: http://www.nation.co.ke/Features/DN2/Policing+the+drugs+business+/-/957860/1373432/-/item/0/-/137y6o7/-/index.html

I have not read the print version of this article, but the author had not declared any potential conflict of interest that we the readers should consider when reading this article. Other than that I think the writer has a valid point, and Pharmacy and Poisons Board (PPB), the beneficiary of the TruScan technology needs to consider this as they go ahead and use this 'donation'. The Board members, who generally represent larger pharmaceutical sector, with heavy representation from the Pharmaceutical Society of Kenya (PSK), should be clear on what this scan technology can do and what it can't. That is why the PPB employs experienced pharmacists who should be able to use intuition, common sense, practice knowledge, well thought out drug policing strategies with a wide reach and finally the TruScan to identify the true counterfeits. I'm a pharmacist, and naturally I'm interested in knowing what technology the TruScan machine uses. Does it use infra red, MRI, UV or rapid chemical tests to identify active ingredients in a drug? If it does that, and that can be validated, then it is able to scan for the presence of the active medicine in any drug, brand or 'generic'. Is the 'analysis' that it does quantitative or qualitative? You need to know both attributes to declare a medicine a 'counterfeit'. In pharmaceutical science, too little of the right medicine is a bad thing and too much of it is still a bad thing.


 If the TruScan is not looking for an active ingredient, then is it scanning the primary and the secondary packages of the medicines to identify 'genuine packs'? And is knowing that just the pack is genuine good enough?


 Does TruScan just 'scan' Pfizer products, all the branded products, or it 'scans' all licenced for use and registered for trading pharmaceutical products? Who is the inventor of this technology? This is the kind of information that I was looking for when I chanced on this article, but did not find.


Remember, there is also competition between branded product manufacturers, and Pfizer here does seem to take up the burden of 'funding' an initiative that benefits all the multinationals whose products get faked. Why is it that it is only Pfizer which is purchasing this TruScan? Why would Pfizer fear generic products more than other manufacturers of branded pharmaceutical products, yet it has a wider range of medicines and still a respectable market share of each, and absolute market share for some? The article should either address Pfizer directly or generalize only when there is involvement of other multinational companies, otherwise the message will be construed to be views that are not necessarily objective.

It is my considered opinion that a counterfeit is that which claims to be what it is not. As a pharmacist, I do not perceive generics as counterfeits. I almost daily have to reassure a nervous client who has a mistaken idea of what generic drugs are, and educate them on the concept at the same time. I also know that it is the branded drugs, that many of us tend to rush to, that are the targets of the counterfeiters and not the generic brands.

I would then understand if the big pharmaceutical companies come together to address the problem that is unique to them. They lose the most to counterfeits, and gain the most if counterfeits are wiped off the pharmacy shelves. If people were to shift en masse and buy generic brands, the counterfeiters will go there. In Kenya now, generic brands, suffer the least when it comes to counterfeiting, and when it comes to fighting these counterfeits, it will make sense to focus on the branded products and get the companies affected on the board because they have everything to gain from such an initiative and so do the public.
A good every day example of counterfeiting are the paper currency notes counterfeiters and their motivation. They do not bother with a fifty shillings note: but they do fake the one thousand note where they are assured of higher returns if not, or before they are detected.

A survey preferably funded with public funds or by companies without their direct involvement in the processes, is welcome as the writer has suggested, identifying the true extent of the influence of counterfeit products in the market, its supply channels and its effect on public health. The survey should not just end there, but also suggest actions required to address the menace once and for all.

Pharmacists also know that just having a genuine product is not good enough. Before it gets to the right patient at the right dose and for the right medical condition, it must also be stored right. If a pharmacy does not store products in a way to preserve chemical integrity, buys from suppliers who don't do so, or worse still, buys from suppliers who they have no idea how they handle and store medicines, then the patients will still suffer, even when presented with a 'genuine product'.



Finally, I feel very uncomfortable with conversations that happen in virtually almost every pharmacy that this one medicine is 'original' that one 'is not'. Who will take up a product that is 'not original' even if the intention was to say this one is 'branded' and the other is a 'generic brand'? It is very unprofessional and not a priority conversation, when there are so many things to talk about that will benefit the patient the more: like the patient's medical condition; how to use the medicine and what to expect from the medicine. The patient is also supposed to be equipped with the knowledge on what to do if an expected positive outcome of the medicine does not occur or an expected negative outcome does occur!

A Challenge to 21st Century Kenyan Pharmacists who are still Sitting on the Fence

Pharmacy of today appears as a collection of disputatious factions and splinter groups still ‘a profession in search of a role’and a profession unable to choose from a bewildering variety of functions and unable to overcome a variety of ‘barriers to clinical practice’.


We will not solve this problem by introspection. It will not help to clarify, list, or debate more functions for pharmacy. The element that is missing as we define our role during this period of transition is our conception of our responsibility to the patient. Some pharmacists have not yet identified patient-care responsibilities commensurate with their extended functions, and the profession as a whole has not made CLEAR SOCIAL COMMITMENT that reflects its clinical functions. Some pharmacists will remain mired in the transitional period of professional adolescence until this step is taken.


Pharmaceutical practice must restore what has been missing for years: a clear emphasis on the patient’s welfare. Professional maturity has much in common with maturity as a person. One attribute common to both is a word view, an expectation that one thrives best by using one’s power t serve something bigger than oneself. Another attribute common to both is acceptance of responsibility for one’s actions.
Drugs do not have doses, patients have doses.



(Charles D. Hepler and Linda M. Strand statement back in March 1990 in an American Journal of Hospital Pharmacy)